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1 International Journal of Health Sciences and Research ISSN: Case Report Management of Cervical Spondylosis with Dashamoola Oil Manya Vasti and Internal Bhusal Nirmal 1, Bhatted Santosh Kumar 2 1 PhD Scholar, NIA Jaipur, India. 2 Associate Professor and Head, Department of Panchakarma, NIA Jaipur, India Corresponding Author: Bhusal Nirmal Received: 29/07/2016 Revised: 22/08/2016 Accepted: 26/08/2016 ABSTRACT Cervical Spondylosis is a degenerative condition of the cervical spine. Pain and stiffness are the primary symptoms. Often, there may be referred symptoms in the upper limb. Radiation of pain from shoulder to digits along the course of the nerve indicates nerve root compression. 66% of adults experience neck pain in their lifetime and 5% are highly disabled by it. Cervical Spondylosis can be co-related with Manyastambha in Ayurvedic prospective. A 42 year female patient had pain & stiffness in the neck and tingling sensation in right upper limb. On examination there was decrease range of cervical movement. On X-ray findings spondylotic changes were seen in the cervical spine. Patient was treated with Manya Vasti with Dashamoola oil and certain Ayurvedic internal medicines (Withinia somnifera, Asparagus recemosus, Glycerhiza glabra, Kaishor Gugullu, and Dasamoola Kwatha). There was marked improvement in pain and full range of movement was achieved. Cervical Spondylosis though is difficult to manage, but Manya Vasti combined with internal medicines can be good option for better management. Key words: Cervical Spondylosis, Manyastambha, stiffness, Manya Vasti, Dashamoola. INTRODUCTION Cervical Spondylosis is a degenerative condition of the cervical spine. [1] Pain and stiffness are the primary symptoms. Often, there may be referred symptoms in the upper limb. Radiation of pain from shoulder to digits along the course of the nerve indicates nerve root compression. Paraesthesia in the form of tingling, pins and needle may be present in the hand. [2] Cervical Spondylosis may affect males earlier than females. 66% of adults experience neck pain in their lifetime and 5% are highly disabled by it. [3] By age 60, 70% of women and 85% of men show changes consistent with Cervical Spondylosis on X-ray. [4] Cervical Spondylosis can be corelated with Manyastambha in Ayurvedic prospective. [5] Manyastambha has been enumerated in eighty Nanatmaja Vata Vyadhis. [6] According to Monier Willium, Manya means the back or the nape of the neck. [7] The meaning of the word Stambha is Nischalikarana. Stambha means stiffness, rigidity, make stiff or immovable. Thus Manyastambha is the clinical entity in which the back of the neck becomes stiff or rigid and the movements of the neck are impaired. The Symptoms of Cervical spondylosis with radiation of pain from shoulder to digits, Paraesthesia in the form of tingling, pins and needle can be correlated with Viswachi but Primary symptoms indicate towards Manyastambha. International Journal of Health Sciences & Research ( 524

2 According to Acharya Sushruta, sleep in day time, leaning or sleeping on an uneven place, constantly gazing upwards lead to the disease Manyastambha. [8] CASE STUDY A 42 year female patient came to the Panchakarma OPD at National Institute of Ayurveda Jaipur, India with complaint of pain and stiffness in the neck. As per patient, she was asymptomatic before 4 years back and then she developed mild, aching type of pain. Since last 4 months the pain radiated to Right upper limb. It was also associated with tingling numbness in middle and ring finger. There was heaviness in the neck region with painfull neck movements. Patient did not get proper relief in last 4 years from different treatments (Physiotherapy, local analgesic ointment and NSAIDs), so came to National Institute of Ayurveda for Treatment. Dietary history shows that she had irregular food habit and vegetarian diet with dominant Rasa (taste) Amla (sour). No any history of addiction was present. No personal and family history of any major systemic illness was present. Stress regarding the disease was present. On physical examinations patient was found afebrile with Blood pressure - 110/70 mm of Hg, Pulse rate - 80/minute, R.R. - 20/minute. On Systemic examination no abnormality was found in respiratory, cardiovascular and central nervous system activity. On examination neck stiffness was present with decrease range of cervical movement. Patient was admitted having I.P.D. NO There was No any significant finding on lab Investigation done on NIA Central Lab. X-ray findings were Suggestive of Spondylotic changes in cervical Spine (Image No:1). Image No: 1. X-Ray of cervical spine showing spondylotic changes. No any specific Nidana was found. The patient was Vata Pitta Prakruti, having Madyam Koshtha and Madyam Bala. Rasavaha, Medovaha, Mamsavaha, Asthivaha and Majjavaha Srotodushti Lakshanas were observed. Range of movement assessment was done with the help of Goniometry and for pain Numeric pain Rating Scale was taken. Patient was treated with Manya Vasti and certain Ayurvedic Medicines. Manya Vasti Procedure Manya Vasti is a treatment procedure in which medicated oils are poured and pooled for a fixed duration of time in a compartment or a cabin constructed over the nape of the neck using wet flour of black gram. In simple words, Manya Vasti is pain relieving oil-pooling treatment conducted for neck and upper back pain with associated symptoms. Pre-treatment: Collection of required Materials- Dashamoola oil, Flour of black gram, water, heating apparatus/ stove, bowls, vessels, spoons, towel, Sponge etc. Abhyanga (light massage) to the neck and upper back region with Dashamoola oil and hot fomentation was done. International Journal of Health Sciences & Research ( 525

3 Treatment: Manya Vasti was done in the morning for consecutive 7 days. The patient was made to lie face down on the Droni (treatment table). Finely pounded black gram flour was taken in a bowl or vessel. Water was added to it (preferably warm water) and kneaded well so as to prepare a bolus. From this bolus a ring was made. The ring was having a diameter so as to accommodate and enclose the vertebras of neck and 2-3 vertebras of thoracic region. The height of the ring was 4-5 inches. The junction of the ring and skin was sealed with wet flour. A small amount of oil was now poured in the ring (compartment) of flour and checked for leakage. Manya Vasti was started after confirming that there was no leakage at the base of the walls of the ring. Dashamoola oil 250 ml was taken in a bowl and heated passively. The bowl was kept in the vessel filled with hot water. When the oil got warm, the bowl was removed. Oil was poured into the compartment (space within the constructed ring of wet flour). Care was taken to maintain the comfortable temperature to the patient in the Manya Vasti pool. The temperature was maintained uniform throughout the procedure. For this to happen, the oil from the pool was removed at regular intervals (leaving some oil in it i.e. oil should not be completely removed) and replaced by warm oil (on the other side, simultaneously oil was passively heated.) Post procedures: At the end of fixed duration meant for completing a schedule (35-45 minutes roughly) the oil was slowly removed from the pool and stored in a container or bottle. On the next day, the same oil was reused after adding some more oil. The whole oil was replaced after 3 days of the treatment. A light massage was given using the same oil for 5 minutes. Care was taken not to apply more pressure while massaging. Internal Medicines Dasamoola decoction 40 ml 2 times a day on empty stomach morning and evening, Aswagandha (Withinia somnifera), Sathawari (Asparagus recemosus), Madhuyesthi (Glycerhiza glabra) churna 2 gms each 3 times a day with a cup of milk and Kaishor Gugullu 500mg three times a day with warm water after food for consecutive 7 days during hospital stay and during follow up was adviced. Dashamoola decoction was freshly prepared every time from Dashamoola i.e. combination in equal quantities of the roots of following 10 herbs: Bilva (Aegle Marmelos), Agnimantha (Premna mucronata), Shyonaka (Oroxylum indicum), Patala (Stereospermum suaveolens), Gambhari (Gmelina arborea), Shalaparni (Desomodium gangeticum), Prishniparni (Uraria picta), Brihati (Solanum indicum). Kantakari(Solanum xanthocarpum), and Gokshura (Tribulus terrestris). 10 gm coarse powder of Dashamoola was boiled with 16 times water (160ml). It was boiled until 4 parts water was remaining, i.e. reduced to ¼ quantity of the content (40ml). The decoction thus prepared was filtered through a cloth or sieve into a small vessel and taken in the morning and evening before food twice daily. RESULTS Table 1: Goniometry measurement of the Range of Movement of Cervical Spine Range Of Movement Before Treatment After Treatment On Follow Up Flexion Extension Rotation to Right Rotation to Left Lateral flexion to Right Lateral flexion to Left Pain assessment with Numeric Pain Rating Scale recorded was before treatment -7, after treatment -2 and after follow up- 1. On the day of discharge (After 7 days of Manya Vasti) and internal medicines patient had marked relief in pain and tingling International Journal of Health Sciences & Research ( 526

4 numbness. There was no stiffness and full range of cervical movement was possible. On follow up after 30 days patient had no any stiffness and marked improvement was present in symptoms. Patient was very happy and satisfied with the management. DISCUSSION In this disease Samprapti (pathogenesis) is at Manya Pradesh and is mostly associated with changes in cervical vertebral column. There is degeneration of intervertebral disc and lubrication function of Shleshaka Kapha is affected which results in compression, irritation or inflammation in Manya Pradesh resulting in pain. Therefore local Snehana and Swedana are very effective and give quick result because they act at the site of Samprapti. Manya Vasti is a procedure in which both the properties of Snehana and Swedana are incorporated. Manya Vasti comes in direct contact with painfull region and Vata Dosha is Sheeta, Ruksha and Manya Vasti being Snigdha and Ushna in nature alleviates the disease. Swedana increases sweat and brings out Maladravyas along with sweat. It decreases Kleda in the body resulting in the reduction of Gaurava (heaviness), and Stambha (stiffness). Application of therapeutic heat causes vasodilatation, because of which the blood circulation improve, resulting in the removal of catabolic waste such as lactic acid. As the blood circulation improves the anabolism increases as tissue receives the nutrients and oxygen promptly. Heat results in an increase in the local metabolism of the cell and increase transport through the cell membrane. For every increase in one degree Celsius within the physiological limits the metabolic activity increase by about 10%. Heat can improve the elasticity of fibrous tissue. The viscosity of matrix decreases, consequently connective tissue such as tendon tissue and ligament will also become more elastic. Because of Manya Vasti the muscles supporting the cervical spine get strengthen. So pressure gradient on cervical spine gets reduced. Dashamoola oil used for Manya Vasti may help to lubricate the joints. Thus Manya Vasti relieves pain and stiffness in the back, relieves swelling and inflammation in the back. Manya Vasti with Dashamoola oil may have nourished the joints of the neck region, pacified the Dosha causing pain or discomfort. Internal Medication Dashamoola decoction all Dravyas have Vata Shamak property and most of the ingredients have Vata Kapha Shamak property. Dashamoola poses antiinflammatory and analgesic action. The action of the constituents of Dashamoola decoction break the basic pathology of cervical spondylosis consequently helps in relieving its clinical features. Kaishora Guggulu, acts as analgesic and antiinflammatory. Being a good Rasayana Kaishora Guggulu was preferred. Aswagandha (Withinia somnifera), Sathawari (Asparagus recemosus), Madhuyesthi (Glycerhiza glabra) churna were advised as Dhatu Suddhikara and Rasayana. CONCLUSION There was marked improvement in the sign and symptoms of cervical spondylosis. Cervical Spondylosis though is difficult to manage, but Manya Vasti combined with internal medicines can be good option for better management. REFERENCES 1. Shah N Siddharth, API Textbook of Medicine, 7 th Edition Mumbai: The Association of Physicians of India, 2003, (Page no-885, 886). 2. Maheshwari J, Essential Orthopaedics; New Delhi: Mehta Publishers, 2007 (page no- 254). 3. Domino Frank, The 5-minute Clinical Consult, Philadelphia: Lippincott Wiilliams and Wilkins 2008 (Page No- 240) Varghese Shibu, Bird s Eye View on The Radiological Diagnosis of Spinal Disorders and Their Pancakarma Management: Kalarickal Vaidhyasala, 2012 (Page no-35). International Journal of Health Sciences & Research ( 527

5 6. Pandey Kashinath, Upadhyay Upadhyay Gorakhnath, Charak Samhita Vol 1 (Chapter 20, Sutra Sthan), Varanasi, Chaukambha Sanskrit series publication, Sir M. Monier Williams, Sanskrit English Dictionary; Reprint Motilal Banarasidass publishers, 1995(Page No- 789) 8. Shastri Ambikadutta, Susruta Samhita Vol 1 (Nidana Sthan, Chapter 1/67), Varanasi, Chaukambha Sanskrit series publication, 2009 p. 63. How to cite this article: Nirmal B, Kumar BS. Management of cervical spondylosis with dashamoola oil manya vasti and internal medicines - a case study. Int J Health Sci Res. 2016; 6(9): *********** International Journal of Health Sciences & Research (IJHSR) Publish your work in this journal The International Journal of Health Sciences & Research is a multidisciplinary indexed open access double-blind peer-reviewed international journal that publishes original research articles from all areas of health sciences and allied branches. This monthly journal is characterised by rapid publication of reviews, original research and case reports across all the fields of health sciences. The details of journal are available on its official website ( Submit your manuscript by editor.ijhsr@gmail.com OR editor.ijhsr@yahoo.com International Journal of Health Sciences & Research ( 528